Melanoma Wide Excision
Wide local excision is a common and effective local treatment for Stage 0 to Stage 2 Melanomas, including:
- Severely atypical lesions
- Melanoma in situ
- Invasive Melanomas with a depth of 0–2 mm
What The Procedure Involves
During a wide local excision, Dr. Guillemaud removes the melanoma along with a margin of healthy tissue surrounding it. This procedure goes through the fatty tissue layer beneath the skin, down to—but not including—the muscle.
The amount of surrounding tissue removed is based on the Breslow depth (how thick the melanoma is), which is determined from your biopsy pathology report.
After reviewing your report with you, Dr. Guillemaud will typically recommend removing 0.5 to 2 cm (about ½ to 1 inch) of healthy tissue around the melanoma to ensure the best chance of complete removal.
Why Removing Extra Tissue Matters
This additional margin of healthy skin and tissue is removed to reduce the risk of recurrence.
If this extra tissue is not removed, there is a 30–60% chance that the melanoma could return at the original site.
Personalized, Evidence-Based Care
Every step of the wide local excision is guided by evidence-based recommendations and tailored to your individual case. Our goal is to not only remove the melanoma completely but also to minimize the chance of it coming back, giving you the best long-term outcome possible.
Surgical marking
At the start of your procedure, Dr. Guillemaud will carefully mark a 0.5 to 2 cm margin around the original melanoma site. This margin depends on the thickness of your melanoma, as outlined in your biopsy report.
The marking may be placed around any remaining melanoma, which can be seen using a specialized light, or around the scar left behind from your previous biopsy.
To ensure the best healing and cosmetic outcome, Dr. Guillemaud will reshape the circular area into an ellipse (football-shaped) design. This shape helps the skin close more smoothly, allowing the incision to heal in a straight, clean line.
Surgical Closure
Once the melanoma and surrounding tissue have been removed, the area will be closed with sutures. Because wide excisions involve the removal of a larger area of skin and tissue—often several centimeters long—the closure can be tight, and the healing process may take longer than with smaller procedures.
As a result, you can expect to have activity restrictions for several days to a few weeks following your surgery to allow proper healing and reduce the risk of complications.
In most cases, stitches will need to stay in place for 14 to 21 days. Occasionally, if the incision is under minimal tension, absorbable sutures may be used instead..
Indentation after Melanoma wide excision
During a wide excision for melanoma, all of the fat beneath the melanoma is intentionally removed. When the remaining tissue is brought back together and sutured, this can result in an indentation beneath the surgical site.
This is done deliberately to allow for better visualization and monitoring of the underlying blood vessels and nerves—a step that’s especially important in melanoma treatment. While this type of indentation is not typical in most other skin surgeries, it is a standard part of melanoma excisions.
Over time, some patients may notice the indentation becomes less noticeable, but for many, some degree of indentation may remain permanently.
Reconstruction
In some cases, the excision may be too large for the surrounding skin to stretch and close the area on its own. When this happens, advanced reconstruction techniques may be needed to properly close the wound.
One option is a rotation or advancement flap, which involves loosening nearby skin and tissue from its underlying structures and repositioning it to cover the surgical site.
If a flap isn’t possible, a skin graft may be used instead. This involves transplanting skin from another part of your body—such as behind the ear, the collarbone area, or lower abdomen—onto the area where the melanoma was removed.
These techniques help ensure proper healing and restore function and appearance as much as possible.
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